Partners TeleStroke Center
TeleStroke Center

Testimonial From Dr. Hirshberg

An Outline of TeleStroke at Martha's Vineyard Hospital

Dr. Hirshberg participating in a TeleStroke consultationOur hospital’s TeleStroke Program started in the Spring of 2000 as a novel way to bring Stroke expertise to a rural area that did not have the financial or personnel resources to have a specialist on staff to be ready 24/7 to deal with Acute Stroke as well as having a geographical barrier as our hospital is located on an island approximately 7 miles off of the coast of Massachusetts.

The equipment consisted of a "Polycom" unit capable of using ISDN lines able to perform real time video conferencing. The system was sent as a kit and I was able to assemble it without any problems.

"A number of patients were able to be successfully treated on the island without transfer off-island increasing patient satisfaction and saving limited health care resources."

The hospital allowed one of the Emergency Department rooms to be equipped with the appropriate wires and the plan was to use the hospital’s existing Teleradiography links in the radiology department with Massachusetts General Hospital to transfer CT images to the Stroke specialist as well.

Before the system was used for patient care, a multidisciplinary committee was assembled to create a standardized pathway to follow national NIH guidelines using evidence based medicine to treat patients with acute stroke. The pathway was designed to treat patients who might require thrombolytic therapy as well as those patients who might be treated on the island as well as to establish a standardized rehabilitation protocol to treat patients returning to the island from treatment at a tertiary care facility off-Island. This team was composed of primary care and emergency physicians, local pre-hospital EMS representatives, a local neurologist, rehabilitation specialists, x-ray technicians, nursing, hospital maintenance, dietary services, social services, hospital quality assurance/administration, and laboratory services to name a "few." The goal was to get input into the pathway from all those areas of the hospital which may directly or indirectly affect the patient’s care and establish a continuum of care that might start with an initial 911 call through to the patient’s discharge from the hospital.

Focused standardized training regarding the NIH Stroke Scale was done for all Emergency Department physician and nursing personnel. EMS personnel were trained to use a pre-hospital screening tool and a glucometer system was successfully set up in 2003 under a state waiver program to assist with patient screening for hypoglycemia potentially presenting as a stroke. Standardized patient forms were developed for use on the pathway. The emergency department’s equipment was checked on a regular basis to ensure that the system could be ready to go 24/7. The hospital participated in the "Coverdell" project to assist with collection of patient consultations regarding patients treated for a stroke. Follow-up of the pathway was done at 3, 6, and 12 month periods to check to potentially fine-tune the pathway but feedback was quite good and no major changes were recommended.

Problems were primarily related to the "human" links of the system and not the technology. The local neurologist was often not available in a timely manner and was subsequently taken off of the call list for questions related to thrombolysis of patients in lieu of contacting the MGH neurology specialist directly through phone or the ISDN line as the MGH physician was available 24/7 by pager. Occasionally, the MGH physician was unfamiliar with the system or was at home where he/she did not have a way of accessing the system. Occasionally the radiology report of the head CT was not available in a timely manner. These problems were dealt with by phone and did not appear to have any patient related problems. The need for retraining and/or refresher training is being reviewed.

Although the vast majority of the patients did not require thrombolysis, many patients with acute stroke and other neurological problems were successfully treated and assessed where previously this level of assessment would have been unable to have been done. A number of patient’s were able to be successfully treated on the island without transfer off- Island increasing patient satisfaction and saving limited health care resources. Patients’ and patient’s family feedback was overwhelming positive and it was hoped that the program could be expanded to include other areas of medicine as well.

Please feel free to contact me if you have further questions regarding the system. Although I will soon be leaving Martha’s Vineyard, I am happy to answer any questions you may have regarding the establishment and maintenance of the system at Martha’s Vineyard Hospital.

Alan J. Hirshberg, MD, MPH, FACEP, (former Emergency Department Director Martha's Vineyard Hospital)
September 2, 2004

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